skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. Information for Medicare beneficiaries is only available on the medicare.gov website.
En Español
Text Size:
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 7/3/2018 Location: FL, PR, USVI Business: Part A, Part B

QMB remittance advice issue

Issue
Payers secondary to Medicare are not able to process some direct billed claims due to patient responsibility deductible and coinsurance amounts on the Medicare remittance advice showing zero. On October 2, 2017, change request 9911 modified Qualified Medicare Beneficiary (QMB) claims to indicate QMB status of patients and reflect zero cost-sharing liability. The change resulted in issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the remittance advice.
Resolution
On December 8, 2017, Centers for Medicare & Medicaid Services (CMS) systems will revert back to the previous display of patient responsibility for QMBs on the Medicare remittance advice. After this temporary fix, a permanent solution is tentatively scheduled for summer 2018. First Coast Service Options will provide updates as it monitors the situation.
Status/date resolved
Open
Provider action
Please refer to this article external pdf file on the CMS website for a guide to identify cost-sharing amounts. Providers may also submit any questions to providerservices@cms.hhs.gov. Note that the provider call center is unable to provide a resolution at this time.
Current processing issues
Here is a link to a table of current processing issues for both Part A and Part B.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.